Inhaled amphotericin B to prevent invasive fungal disease in patients with severe aplastic anemia after intensive immunotherapy

Abstract

Abstract Objective To evaluate the efficacy and safety of aerosol inhalation of amphotericin B (AmB) in preventing invasive fungal disease (IFD) in patients with severe aplastic anemia (SAA) after intensive immunosuppressive therapy (IST). Methods The efficacy and safety of aerosol inhalation of amphotericin B or gargling with sodium bicarbonate/nystatin to prevent IFD in SAA patients within 28 days were compared. Thirty-three cases were assigned to the Am AmB nebulization group and 65 cases to the mouthwash group. Breakthrough fungal infection and related mortality were evaluated. Results Five cases of breakthrough fungal infection occurred in the AmB nebulization group, compared to 34 cases in the mouthwash group (15.2% vs 52.3%, p = 0.00083). In the 3 months after IST, no patient died of fungal infection in the AmB nebulization group, as compared to two cases in the mouthwash group (0% vs 28.5%, p = 0.021). No grade III or above AmB-related toxicity events occurred in the aerosol inhalation group. Conclusion Aerosol inhalation of AmBB could effectively prevent IFD and related mortality in SAA patients during IST, and the treatment was well-tolerated.